基于危机资源管理促进1h集束化治疗在急诊科脓毒症患者中的有效实施  

Effective implementation of hour-1 bundle for sepsis patients in emergency department based on crisis resource management

作　　者：吴成莉 苏家琼 赵立波 夏琴 夏澜 马万宇 王锐霞 Wu Chengli;Su Jiaqiong;Zhao Libo;Xia Qin;Xia Lan;Ma Wanyu;Wang Ruixia(Department of Emergency,the Third Affiliated Hospital of Zunyi Medical University(the First People's Hospital of Zunyi),Zunyi 563000,Guizhou,China;Department of Nursing,the Third Affiliated Hospital of Zunyi Medical University(the First People's Hospital of Zunyi),Zunyi 563000,Guizhou,China;Department of Intervention,the Third Affiliated Hospital of Zunyi Medical University(the First People's Hospital of Zunyi),Zunyi 563000,Guizhou,China;Department of Nursing,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,Guizhou,China)

机构地区：[1]遵义医科大学第三附属医院(遵义市第一人民医院)急诊科,贵州遵义563000 [2]遵义医科大学第三附属医院(遵义市第一人民医院)护理部,贵州遵义563000 [3]遵义医科大学第三附属医院(遵义市第一人民医院)介入室,贵州遵义563000 [4]贵州医科大学附属医院护理部,贵阳550001

出　　处：《中华危重病急救医学》2025年第1期23-28,共6页Chinese Critical Care Medicine

基　　金：贵州省遵义市科技计划项目(遵市科合HZ字(2022)24号)。

摘　　要：目的探讨危机资源管理(CRM)体系在脓毒症患者1 h集束化治疗中的实施效果。方法采用历史对照研究方法,于2022年10月至2023年3月对24名急诊科护士进行基于CRM构建的脓毒症1 h集束化治疗方案的培训干预,收集2022年4月至2023年9月遵义市第一人民医院急诊科收治的脓毒症患者的临床资料。根据CRM体系构建不同时期将患者分别纳入对照组(构建前,2022年4月至9月)、改进组(构建过程中,2022年10月至2023年3月)及观察组(构建后,2023年4月至9月)。收集患者的基线资料、1 h集束化治疗执行情况〔包括血液培养、使用抗菌药物、血乳酸(Lac)检测、液体复苏、使用升压药〕、识别诊断时间及预后情况〔包括低氧血症纠正率、重症监护病房(ICU)住院率、28 d生存率〕;分别于培训前后对急诊科护士进行脓毒症认知情况调查及非技术技能(NTS)评价。结果对照组、改进组及观察组最终均纳入43例脓毒症患者,3组患者性别、年龄、感染原发部位、心率、收缩压、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、机械通气比例等基线资料差异均无统计学意义,具有可比性。随着CRM体系的逐步完善,1 h集束化治疗执行率逐渐升高,对照组、改进组及观察组执行率分别为65.12%(28/43)、74.42%(32/43)、88.37%(38/43),3组间比较差异有统计学意义(P<0.05),主要体现在观察组1 h内血液培养完成率、抗菌药物使用率、Lac检测率及升压药使用率均显著高于对照组〔血液培养完成率:90.70%(39/43)比62.79%(27/43),抗菌药物使用率:88.37%(38/43)比60.47%(26/43),Lac检测率:93.02%(40/43)比72.09%(31/43),升压药使用率:88.37%(38/43)比60.47%(26/43),均P<0.05〕;3组液体复苏完成率均大于90%,差异无统计学意义。观察组识别诊断时间较对照组和改进组显著缩短(h:0.41±0.15比0.61±0.21、0.51±0.18,均P<0.05),低氧血症纠正率及28 d生存率较对Objective To explore the implementation effect of hour-1 bundle for sepsis patients based on crisis resource management(CRM)system.MethodsA historical control study was conducted.The hour-1 bundle for sepsis based on CRM was used to train 24 nurses in the emergency department from October 2022 to March 2023.Clinical data of sepsis patients admitted to the emergency department of the First People's Hospital of Zunyi from April 2022 to September 2023 were collected.The patients were divided into three groups based on different stages of CRM system construction:control group(before construction,from April to September in 2022),improvement group(during construction,from October 2022 to March 2023)and observation group(after construction,from April to September in 2023).The baseline data,implementation rate of hour-1 bundle[including blood culture,antibiotic usage,blood lactic acid(Lac)detection,fluid resuscitation,hypertensors usage],identification and diagnosis time,and prognosis parameters[including correction rate of hypoxemia,intensive care unit(ICU)occupancy rate,and 28-day survival rate].Sepsis cognition survey and non-technical skill(NTS)evaluation of nurses in emergency department were conducted before and after training.ResultsFinally 43 cases were enrolled in the control group,improvement group and observation group,respectively.There was no statistically significant difference in baseline data including the gender,age,primary site,heart rate,systolic blood pressure,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,mechanical ventilation ratio among the three groups with comparability.With the gradual improvement of the CRM system,the implementation rate of 1-hour bundle was gradually increased,and the implementation rate in the control group,improvement group and observation group were 65.12%(28/43),74.42%(32/43)and 88.37%(38/43),respectively,with statistically significant difference(P<0.05).It was mainly reflected in the completion rate of blo

关 键 词：脓毒症 危机资源管理 1 h集束化治疗 执行率 非技术技能 

分 类 号：R459.7[医药卫生—急诊医学]